| NPI | 1699790865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 7848) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MI 6801087203) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2016-06-24 |